Embracing the Fourth Trimester

Here comes the fourth trimester! After three blissful trimesters of pregnancy, it’s time to give some extra care to this one. The fourth trimester is the postpartum period. But trust me, this doesn’t just get over after 12 weeks.

Postpartum is forever! We all work hard to make sure we are eating right, exercising, staying happy but as soon as we deliver the whole world revolves around a beautiful baby you created.

A postpartum plan is as important as having a birth plan. 

How to take care of yourself while taking care of a new baby?

The best way is to plan ahead. It’s a great idea to enrol yourself in a program that can guide you on how your body is changing post-delivery and how to cope with daily stressors and work towards a stronger self.

Here are some tips :

  • Set aside 15 min for yourself each day. 
  • Perform some week appropriate light exercises instead of rushing to the gym and starting a workout. Talk to a postnatal fitness specialist.
  • Work on your posture while you are feeding, lifting the baby or performing your day to day activities.
  • Meditate.
  • Take help when offered.
  • It’s ok to take a break and sneak out for some self-care such as going for a spa or massage.
  • See a pelvic floor physical therapist if you are experiencing any pelvic floor symptoms.
  • Most importantly embrace your body as you embrace motherhood.

Happy mother = Happy baby

Are you a physiotherapy graduate and wondering what is the best career choice for you?

Physiotherapy career choices
Physiotherapy career choices

Whether you are a newly qualified physiotherapist or someone with years of experience you should always look for opportunities to develop in your career. This is what I do, like everyone I started at the bottom of the ladder and since been working towards developing in my career. 

I am often asked by newly qualified physiotherapists, colleagues and friends about what should be their next step in their career. So I thought I will put down my top 5 career choices.

They are 

  1. Musculoskeletal & Sports Physiotherapist
  2. Respiratory Physiotherapist
  3. Rehabilitation Specialist
  4. Clinical Lead
  5. First Contact Practitioner(FCP)
  1. Musculoskeletal & Sports Physiotherapist: If you are passionate about sports and have always wanted to know what every muscle, bone, ligament and tendon combination can do, then this could be for you. 

You can work in out-patient units, independent clinics or in the community.

Pros: You’ll be able to see results within specific periods. And there could be some employers who might not want you to work on weekends. But remember the best exposure in sports happens over weekends.

Cons: Working in this field for a long term can become physically exhausting after a few years so it is very important to take it easy on yourself. 

  1. Respiratory Physiotherapist: If you are someone who wants to make a difference when it could be a life or death situation-this is for you. Your contribution can be immense for those who are struggling with their breathing and mobilisation.

You can work in wards, intensive care units and step down respiratory centres.

Pros: Compared to MSK, respiratory can be less physically demanding as you tend to find help from other staff in ICU and wards. As you work in ever demanding critical care units, it can make you stronger as an individual.

Cons: You definitely have to forget weekends and be prepared for on-call and night duties.

  1. Rehabilitation Specialist: Do you like giving your best and getting involved with the journey of your patient’s recovery? Then this can be you. 

You can work in both Sports, Orthopaedic and Neuro outpatient departments or rehab centres.

Pros: As a rehab specialist, you will be developing your skills by attending various multidisciplinary CPD (continuing professional development). You will be able to independently plan your patient’s recovery program.

Cons: Rehab specialists can become mentally exhaustive; you may struggle to stay motivated esp. with patients expecting passive treatment.

  1. Clinical Lead: This is for the ones who have worked in most of the physiotherapy specialties with extended qualifications and are looking to take the profession to a high standard. If you are a people’s person and passionate about your profession, you can progress in your career by improving the service of physiotherapy in hospitals and the healthcare industry. 

Pros: Working at this level helps you master your emotional intelligence and networking. 

Cons: This role may demand working longer hours with more responsibilities which in return may induce stress.

  1. First Contact Practitioner(FCP): This is the most recent career option available in the UK. You are required to have experience across most physiotherapy specialties and good interpersonal skills. You can also train yourself to become a FCP. 

These practitioners work out from GP practices and can address any MSK related issues in place of a GP.

Pros: As a first contact practitioner you will be exposed to a variety of MSK and non medical cases. This will help you to develop as a better clinician.

Cons: It can be highly demanding and sometimes stressful.

These are just a few from the vast list you could choose. As a profession physiotherapy is blessed with multiple opportunities in each speciality so don’t feel shy to come out of your comfort zone. Leave us a comment if you would like to hear about more opportunities.

Pain Catastrophizing Behavior

Pain catastrophizing and Recovery from Chronic Pain

Pain Catastrophizing behavior:

Catastrophizing of pain is a negative thought process, a feeling of complete denial of recovery where the individual begins to live life with pain. It has resulted in restricted social participation, reduced pace of work and activities of daily living as a result of  a constant fear of motion. A feeling of continuous stress of not being able to carry out an activity without pain often results in anxiety and in some cases a state of depression as well when pain ultimately causes disability.

Pain perception is one of the most important aspects of investigation and diagnosis of chronic pain. Fear-avoidance and catastrophization shapes the cognitive response to persistent pain. These responses are often emotional and behavioral outcomes that have been largely affecting the recovery rate.

The fear-avoidance model:

Avoidance is a human way of escaping danger. However, we are unaware of the fact that it is even more dangerous to avoid an activity in fear of getting hurt. Avoiding the use of the body part causing pain perpetuates the abnormal pain behavior resulting in a long term disability even in the absence of an underlying pathological cause.

The fear-avoidance model by J.W. Vlaeyen and S.J. Linton, 2000 describes the consequences of pain-related fear and pathway of recovery.

Movement related fear of pain after injury causes disuse and at last disability on catastrophizing for a prolonged period of time. What becomes more dangerous than the injury itself is the exaggeration of its effects and pessimism to recover from the injury. A negative thought process by an injured individual about what has happened and prediction of false future consequences out of fear can drastically increase the intensity and frequency of an acute pain and might not take a long time in converting the acute pain into persistent and finally chronic pain.

At the stage of chronic pain, the injury is often healed but the fear persists.

The fear of pain often results in reduced work capacity, increased absenteeism, low social interaction, reduced productivity etc. in many cases it has also resulted in negative body image and overthinking affecting interpersonal relationships along with work.

A negative perception of pain is often related to past experiences of pain, traditional and cultural influences and trial and error. Understanding of pain from such perspectives often gives a false belief to the individuals dealing with pain creating a cycle of negative thought process, catastrophization, fear-avoidance behavior, diause and disability.

Risk factors associated with chronic pain:

There are several individual, physical and psychological risk factors that are associated with the development of chronic pain. These factors are often not addressed as when the biomedical model of investigation and management is used. Adaptation of the biopsychosocial model of pain on the other hand has shown to increase early detection of factors causing pain and elimination of such factors. Psychological and social risk factors have often played a larger role in chronic pain investigation and treatment. For example, the work environment, work load, interpersonal relationships, social support and interaction. Understanding of the risk factors often paves the way for better recovery in such cases due to identification of the exact cause of pain. However, the method is still not used widely.

The waves of behavioral therapies to combat chronic pain:

The first wave of behavioral and cognitive therapy was the Traditional behavior therapy, which aimed at replacing harmful behavior with constructive ones through conditioning.

The second wave focused on thought changing concepts in which the negative pain related thoughts were discouraged.

The third wave is about behaviorism, spirituality, mindfulness, centering, dialectics and relationship building.

The waves of behavioral and cognitive therapies preferred over time gives us an idea about how pain has been perceived at different points in time by analyzing the approaches used to treat pain related behavior. Adaptation of cognitive and behavioral approaches for recovering from chronic pain needs more attention and modifications. The primary aim of treating chronic pain must be identification of the predisposing risk factors followed by planning a goal-oriented management approach highlighting the emotional and psychosocial aspects. A positive thinking about recovery from pain has resulted in increased rate and early recovery. Breaking of the fear-avoidance cycle is an important aspect of chronic pain management which incorporates a major role of pain education on the basis of evidence based practice.

Thank you.

Dr. Jasrah Javed (PT)

Musculoskeletal and Sports Physiotherapist, Author

Exercise: Key to your mental health!

“Exercise keeps me occupied, which is good for my mental health!”-Gail Porter.

Exercise ensures successful brain functioning. There is a long history of how our ancestors knew the importance of fitness and maintaining an active lifestyle. Some studies suggest that this relationship is a part of the evolutionary process as physical activity is associated with survival. There has been overwhelming evidence of how exercise helps in delaying or preventing the neurodegenerative changes in the brain and also helps in improving mental health.

How does exercise help?

  1. Depression: It is said the exercise is the most underutilized drug for depression! Various studies have supported the role of exercise to improve symptoms of depression. The reason is attributed to the secretion of neurotransmitters like serotonin and endogenous morphine which produce a state of euphoria.
  2. Anxiety: High-intensity exercise has shown to improve anxiety. 20 to 30 minutes of aerobic exercise has a positive effect. Some hypothesis behind the positive effect is increased in temperature causes a decrease in muscle tension. Another possible reason is the activation of the sympathetic nervous system causing an increase in adrenaline. This provides a catalyst for the parasympathetic nervous system and the acetylcholine released causes the calming effect.
  3. Cognitive functioning: It’s an important party of mental health and well being. Regional cerebral blood flow improves with exercise causing an increase in glucose uptake and oxygen. All this will help to improve the cerebral activity.

Incorporate 20 to 30 minutes every day and perform some sort of exercise. Aerobics in form of walking, dancing, jogging, biking. Include strengthening exercises in your routine 2-3 times per week.

It’s never too late to start exercises and continue doing them as a routine. “Sound mind resides in a sound body”!



Ways to ease mommy’s thumb

Happiness has no bounds when you cuddle and hold your baby. We read all the blogs, books and pages on the internet, to update ourselves on how to take care of the baby. But sometimes we forget to know those tips and tricks to prevent aches and pains post-pregnancy. Postpartum or post-pregnancy there are so many changes still happening in the body due to hormones.

Painful wrist and thumb are very commonly seen in new moms and even dads due to repetitive action of picking up and holding the baby, changing the diaper, putting in and out of car seat etc.

Definitely, we want you to continue doing these activities as its best way to bond with the baby, but let’s look into the causes of those aches and pains you may be having and prevent, self test and ease them before it becomes a ongoing problem.

What is Mommy’s thumb/ Dequirvain’s Tendinitis

Mommy’s thumb or Dequirvain’s tendinitis is inflammation of tendons around your thumb and wrist. Pain is typically dull achy and the area near the thumb is tender to touch. You might notice swelling, redness or warmth in acute phase.

How to self test

Check out this video to self assess the reason for your pain.

How to ease the pain

  • Icepack: Icepack works wonders in the acute phase of inflammation. If the pain is chronic for more than 3-4 weeks and you do not notice any warmth or swelling, you may use a heating pack.
  • Gentle range of motion: You do not want your thumb to get stiff. Gentle movements help to improve blood circulation and ease stiffness.
  • As pain improves start with some exercises to strengthen your finger and thumb and wrist muscles.
  • If pain is severe you may briefly use a splint or brace to prevent stress.
  • See a physical therapist, get your condition assessed properly and treat it before it becomes a chronic condition.

Tips to prevent painful thumb

Prevention is always better than cure!

  • Follow right body mechanics while lifting the baby. So instead of picking up the baby u holding under the arms by stretching your thumb out, try scooping the baby under the bottom by keeping your palms facing up and wrist neutral.
  • Follow right body mechanics while lifting the baby. So instead of picking up the baby u holding under the arms by stretching your thumb out, try scooping the baby under the bottom by keeping your palms facing up and wrist neutral.

Happy motherhood!

Why Physiotherapy does not work for everyone?

Have you ever wondered why some people say Physiotherapy did not work for them?

A big part of my clinical consultation involves talking to patients who have been struggling to recover from their injuries or Physiotherapy did not work for them in the past.

The most common reason for this could be either you are pushing yourself too much or you did not get the right Physio.

Whenever you have an injury, like any other disease or condition, you need time to recover. 

Even if it is a mild cold, it does not disappear in a day, does it? So it is the same with any musculoskeletal injury. Normally soft tissue injury can take 6 weeks or more to recover and if you have a fracture, complete recovery can take upto 12 weeks (depending on the bone you fracture).

Damage to the soft tissues(muscle, ligament, tendons) causes inflammation around that area and you can have signs like redness, warmth, swelling, pain and sometimes bruises. 

Let’s make it more simple, imagine you had a cut while working in the kitchen or deep scratch while walking in the woods. Like how these cuts or scratches do not heal in a day, likewise any other injuries need time to heal. 

If you are an active person, it becomes very hard to rest or avoid the sports or activities you love to do. However, it is very important to pace your recovery program. 

Expecting to return to sports or your regular activities too soon because the signs of inflammation have come down can be one of the greatest mistakes that you can make. Once the signs of inflammation are reduced, you need to gradually start building up muscle strength and flexibility. This will prevent excessive loading of the muscle too soon which can lead to irreparable damage.

Some patients that I talk to often refer to seeing Physiotherapists for weeks with no improvement and are just looking for surgical options. I like taking very detailed consultation with such patients as it often turns out that the Physiotherapy program that they were provided was either machine-based passive treatment or too basic or very intensive exercise program.

That is why it is very important to design a customised program as each individual is different. And that can be achieved if we listen to our patients and let them set their goals.

So if you have any ongoing or recurrent pain, please comment and connect.

Riding a tide called motherhood!

Tips from a stay at home mom, a working mother and a grandmother

Motherhood is a fusion of emotions. A mixed bag of sentiments such as joy, the feeling of accomplishments, sometimes guilt and uncertainty. But as years pass by we realize it’s all about how to balance this ride!

The month of March is dedicated to all amazing women. I got the privilege to interview three wonderful mothers. And I am excited to share their perspectives on motherhood.

Meet Pallavi Sapre 41-year-old, Mother of two and a stay at home mom

Question: How long have you been a stay at home mother and what prompted you to stay home with the kids?

Answer: I have been a stay at home mom for 14yrs. I decided to stay at home due to circumstances during and after pregnancy. I somehow couldn’t get back to work as I had my second baby.

Question: What do you think about working moms?

Answer: I have tremendous respect for working moms who can manage both work and family.

Question: What do you do all day and how you plan it?
Answer: Most of my day revolves around the girl’s schedule. Once I get my time then I do some exercise, watch T.V, read, go for a walk with friends, play badminton… etc.

Question: What is the best part of being a stay at home mother?
Answer: It has its perks. I get to stay with my kids all the time…. literally. I enjoyed each moment watching them grow, reaching each and every milestone. This is something I would love to cherish all my life.

Question: What is the piece of advice you would give to another mom who is contemplating becoming a stay at home mom?
Answer: There is no harm in becoming a stay at home mom but don’t get too comfortable with that role that you may not be able to come out of it. Enjoy it fully but at the same time keep in mind that one day you need to get back to work. This is very important as after a few years children will get busy with their own lives.

Question: What do you do to keep your mind and body fit?
Answer: For physical fitness, I play badminton, gym workouts, dance and for my mental wellbeing I go for walk with friends, read books.

Meet Nancy Hsu 42-year-old, Mother of two, Program manager.

Question:  Do you think it is easier or harder to be a working mom?

I feel its both, harder because you are juggling too many things same time. But for me personally, I feel easier as it helps me to stay mentally and emotionally healthier. 

Question: How do you manage the busy schedule, being a wife, mother and working in office?

My mother and husband help me to manage the day. I believe in taking one thing at a time and not get overwhelmed. And when things go bad just let it go.

Question: What is one thing you would like to do more often? 

Working out and having a exercise routine is something I would like to do more often.

Question: What is that one thing you would have done differently as a working mom?

I always wished to have dinner with my family which I often missed due to work and travel. This Pandemic made it possible for me to sit with my family for dinner every single day!

Question: What is the best parenting advice and relationship tips you would offer to other working moms?

Accept help if someone offers. For a successful relationship, its very important you spent quality time with your partner. Focus on what will matter to you after 10 or 20 years. It’s ok to not clean the house one day and spend time doing what you like. For me its spending time with my kids as I know they will soon go to college so each minute I want to make it a memorable one.

Question: What do you do to keep your mind and body fit?

Regular workouts, reading, watching TV, play board games with kids and spend quality time with family and friends. 

Meet Maria Damas, 72-year-old loving mother and a grandmother

Question: You raised 4 kids while your husband travelled for work?? How did you manage everything without losing your mind?

 Answer: I lived in El Salvador. My day started early at 5 AM before the kids woke up. I kept things ready for them and once they went to school I went to the gym to make sure I stay fit. While heading back home from the gym I bought fresh produce and groceries and cooked for my family homemade food. After kids were back from school remaining day was spent helping them with homework, cooking the evening meal and once the kids were off to bed I spent some time “me time” again by reading a book, watching T.V.

Question: What do you think you see parents worry too much these days?

Answer: Kids have easy access to gadgets and technology, and I feel this is what makes parents more worried as they have to be vigilant all the time. I feel back then we had more control over our kids but this might be due to cultural difference in different countries.

Question: What is your best advise to your kids at this point in their life?

Answer: To dedicate more time to kids as they are young and save money to prepare for a better future.

Question: What is your biggest piece of advice for mothers raising children today?

Answer: Discipline and sticking to the rules is very important .

 Question: What do you do to keep your mind and body fit?

Answer: I maintain my schedule and eat healthy food, I do not miss going for a walk, read books, relax and not to get involved in other people’s business.

It was a great privilege to be able to interview three powerful mothers. I realized each one of them has a very positive outlook on their choices of the role they took in their life. The stress on self-care and “living in the moment” is something that touched my heart.

I hope their outlook towards life, parenting and self-care will give you an opportunity to look into a new perspective and bring new light into your life and relationships with your family and with yourself.

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Why do I keep spraining my ankle?

This is a very common problem, and in my day-to-day practice I talk to many patients who are fed up with frequent ankle injuries. To understand this, we initially have to focus on what happens in an ankle sprain.

Normally it is the ligaments stabilising the ankle joint that are affected. The most common type of ankle sprain is where the ligament structure on the outer side of the ankle is damaged. This is termed lateral ankle sprain, and can occur when we twist our ankle outward and place excessive strain on the ligaments present around those areas – the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). 

The severity of the tissue damage depends on the amount of force produced during the injury. Sources of ankle sprain include slipping off steps, stumbling on uneven ground or wearing high heeled shoes. The mechanism of the injury commonly involves the weight of the body rolling over the ankle in an unintended direction. So if your job involves wearing high heels, keeping an extra pair of comfortable flat shoes or sandals could help. You can use them intermittently to avoid continuous load over the tendons and ligaments of your ankle joint.

How can I treat a sprained ankle?

Most simple sprains will heal within two to four weeks by adhering to the following guidance:

  • Protect: Continue your day-to-day activity if you can do so without pain. But refrain from any activity that aggravates or increases your pain
  • Rest: Don’t confine yourself to bed – continue to move your ankle within its normal range of movement
  • Ice: Apply ice to your ankle for up to 15 minutes and repeat every 3-4 hours during the day
  • Compression: You can use a compression bandage to support your ankle. But remove this every few hours to allow your ankle to return to the normal range of motion
  • Elevation: Place your ankle on a cushion so it is above the height of your waist

However you may need the advice of a professional, particularly if – 48 hours after the injury – the ankle remains severely swollen, with a bluish discolouration accompanied with pain when the ankle bears weight. In these circumstances you should contact a Physiotherapist, who will advise on the appropriate level of rest or gentle recovery exercises. Alternatively, their assessment may deem the sprain to be severe enough to require a referral to a doctor.

How can I prevent ankle sprain?

Whether you are stepping out for a walk or any kind of sporting activity, it is very important to warm up and in the same way let your body cool down at the end of the session. Warming up helps to increase circulation, readying the muscle fibres so as to lower the risk of injury. 

Wearing footwear and clothing that is appropriate to your activity is one of the more obvious practices for avoiding an ankle sprain (or, indeed, various other injuries). 

‘Proprioception’ is the body’s ability to perceive its own position in space. For example, if you are running through a forest and suddenly encounter a puddle, it is your proprioception that will determine the ultimate decision made by your brain: to either jump over the puddle or take a step around the side. Whenever you have an ankle sprain, there will be alterations in your proprioception. Ankle stabilisation exercises including proprioceptive training is something that you should consider to prevent first-time or recurrent ankle injury. 

The majority of the ankle sprains I treat seem to occur in patients who have previously suffered one or more sprains. And the common factor with so many of these patients is their previous decision to put up with the pain, opting against any proper rehabilitation that would have maximised their recovery. Given the risk of recurrent sprains, it is concerning that about half of people sustaining an ankle sprain do not seek medical attention. I have many years of experience in the successful treatment of ankle sprains, and welcome contact from anyone who seeks further advice or treatment.

Muscle fever: A positive sign after exercise!

Muscle fever or Delayed onset muscle soreness (“DOMS”, to use the clinical term) is a response of the muscle to an unaccustomed exercise. Sometimes it is mistaken as a muscle strain.

DOMS occurs because of the temporary inflammation or damage to muscle fibres when they are loaded. The soreness begins a day after your exercise and usually peaks at 48 hours.

HOW and WHY does it happen?

  • Concentric (muscle is in shortened position) and eccentric (muscle is in lengthened position) exercises disrupt the structure of the muscle fibre. The effect is seen more in eccentric exercises.
  • Some studies have shown an increase in the muscle enzyme that causes muscle ache.
  • Unaccustomed exercise can cause a build-up of metabolites (a by-product of various chemical processes within the body). This build-up will force an increased pressure on our muscle tissue, with the accumulation of fluid sensitizing the nerves.

Do I have muscle fever or muscle strain?

Muscle strain causes immediate focal pain while contracting concentrically. Whereas DOMS will build over 24 hours before disappearing after 2 to 4 days.

What can I do about DOMS?

  • Active recovery: Light exercises should be performed to improve the blood flow.
  • Stretching: Gentle stretches are effective. Avoid ballistic i.e fast movements while stretching.
  • Foam roll: Gentle massaging effect of foam rolling may help to alleviate symptoms.
  • Massage: Avoid deep tissue massage. Gentle light massage may help with the draining of metabolites in the lymphatic system.
  • Wearing compression garments post-exercise can be an effective way to reduce DOMS and accelerate recovery.
  • Hydration: drink sufficient fluids before, during and after exercise to reduce the likelihood of muscle fever
  • The prevention of muscle fever is the very reason we are taught to perform warm-up and cool-down exercises before and after every fitness session.

DOMS is actually a positive sign that your muscle is recovering into a stronger state. 

Please follow the tips to improve your symptoms and let us know how it helped.

Happy exercising!